Abstract
Study aims
To assess whether increased use of targeted temperature management (TTM) within an
integrated healthcare delivery system resulted in improved rates of good neurologic
outcome at hospital discharge (Cerebral Performance Category score of 1 or 2).
Methods
Retrospective cohort study of patients with OHCA admitted to 21 medical centers between
January 2007 and December 2012. A standardized TTM protocol and educational program
were introduced throughout the system in early 2009. Comatose patients eligible for
treatment with TTM were included. Adjusted odds of good neurologic outcome at hospital
discharge and survival to hospital discharge were assessed using multivariate logistic
regression.
Results
A total of 1119 patients were admitted post-OHCA with coma, 59.1% (661 of 1119) of
which were eligible for TTM. The percentage of patients treated with TTM markedly
increased during the study period: 10.5% in the years preceding (2007–2008) vs. 85.1%
in the years following (2011–2012) implementation of the practice improvement initiative.
However, unadjusted in-hospital survival (37.3% vs. 39.0%, p = 0.77) and good neurologic outcome at hospital discharge (26.3% vs. 26.6%, p = 1.0) did not change. The adjusted odds of survival to hospital discharge (AOR 1.0,
95% CI 0.85–1.17) or a good neurologic outcome (AOR 0.94, 95% CI 0.79–1.11) were likewise
non-significant.
Interpretation
Despite a marked increase in TTM rates across hospitals in an integrated delivery
system, there was no appreciable change in the crude or adjusted odds of in-hospital
survival or good neurologic outcomes at hospital discharge among eligible post-arrest
patients.
Keywords
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Article info
Publication history
Published online: August 30, 2014
Accepted:
August 11,
2014
Received in revised form:
August 5,
2014
Received:
March 14,
2014
Identification
Copyright
© 2014 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
